How Are People Actually Using the ‘Pullout Method’?

New research shows a number of women say they use the withdrawal method as a backup method or in combination with other contraception methods to prevent pregnancy. (Shutterstock)

As a sex educator, I have always been skeptical about the idea of using withdrawal as a method of contraception. I worry that a man might promise to pull out but forget in the heat of the moment. I worry about sperm in pre-ejaculatory fluid, which the latest research suggests some men have and some men don’t. And I worry about sex that is not protected against sexually transmitted infections (STIs) or HIV. Although research has found that withdrawal can be as effective in protecting against unintended pregnancy as condoms, I’m not a risk-taker and I don’t understand why couples would want to rely on “pulling out” when so many other more effective contraceptive methods exist.

As I explained in a piece for RH Reality Check last year, I have been especially concerned at the idea of the so-called pullout generation—30-something women, in long-term relationships, who could easily access and afford other methods but choose withdrawal instead. New research, however, suggests that this cohort might not represent most withdrawal users.

Researchers collected data from a national sample of 4,634 women between the ages of 18 and 39. They asked a number of questions about contraceptive use—both about hormonal methods (such as the birth control pill or shot) and coital methods (such as withdrawal and condoms). They found that among women at risk of unintended pregnancy, 33 percent had used withdrawal at least once in the last 30 days; 13 percent reported withdrawal was the most effective method of contraception they used in the last 30 days; and 12 percent had only used withdrawal in the last month.

The findings on withdrawal show higher use among women than other surveys, such as the National Survey of Family Growth (NSFG), which found that 3 percent of women currently use withdrawal. The authors noted several reasons for these discrepancies. First, they explained that a methodological difference in how they asked the question may have increased the likelihood that women noted withdrawal use. While the NSFG put withdrawal at the bottom of its list of birth control methods, this study put it at the top. Rachel Jones, a researcher at the Guttmacher Institute and the lead author of the study, told RH Reality Check that the group put withdrawal at the top of its list to confirm its standing as a legitimate method. “Women don’t even think of it as a method,” said Jones, “so sometimes they don’t even see it when it’s listed under all the other methods.”

The other major difference is more inclusion of dual-method users. The authors explained that in the NSFG, current use figures represent only the most effective method of contraception that a woman had used in the last 30 days. If a woman said she used both the pill and withdrawal, for example, she was counted as a pill user. The current study included all methods women had used in the last 30 days and found that dual-method use was common. In fact, 28 percent of pill users and 13 percent of users of long-acting reversible contraception methods (LARCs), such as IUDs and implants, reported using withdrawal at least once during the last 30 days. And 33 percent of women who relied on condoms also reported using withdrawal. In response to an additional survey, most dual-method users—77 percent—said they used the two methods at the same time, while 12 percent said they switched between methods.

Jones summarized the findings by saying, “Contraceptive use is messier than we think. Women are using different methods. They are changing their methods over time. Withdrawal is often used as a back-up method or as extra protection.”

Jenny Higgins, a professor at the University of Wisconsin and one of the co-authors of the study, added that the data highlighted two types of users: those she calls “eroticizers of safety,” who are really motivated to prevent pregnancy and add withdrawal to the other methods they are using, and the group of “switch hitters,” who go back and forth between methods depending on what’s available or where they are in their menstrual cycles.

Both authors said that the most striking finding in this study was how many women were using withdrawal as extra protection. As Higgins explained to RH Reality Check, “There is a reputation of withdrawal users as being lazy or ambivalent or uneducated, but at least in this sample they seem to be extra motivated to prevent pregnancy.” Jones added that their study, which included a large, though not necessarily representative, sample of women, does not support the anecdotal stories about the “pullout generation” of women in their 30s who may be ambivalent about pregnancy and rely primarily on withdrawal. In their study, withdrawal users were younger, and use of themethod declined with age. Moreover, the study found that women who expressed strong pregnancy avoidance attitudes had a higher level of reliance on withdrawal (35 percent) and about half of these women were using withdrawal in combination with a highly effective contraception method.

While this study paints a more responsible picture of withdrawal users, I still have a hard time with the promotion of withdrawal as anything other than “better than nothing” or “something to use when you have no other options.” Higgins said that this is part of the problem: “Withdrawal has been unfairly maligned. There is no accepted narrative for how even to talk about its use, and that hurts young people.”

Jones said that I’m not alone, but also suggested a change in message: “I know sex educators don’t like to talk about withdrawal, but we have to recognize that people are using it, so we have to talk about it.” At the very least, she suggested, sex educators should be talking about withdrawal as a good backup method and extra protection against pregnancy for those who are using other methods.

I am willing to take the advice of both of these colleagues, and I do believe that it is important to tell the truth about all contraceptive methods. Withdrawal has undoubtedly prevented countless pregnancies over the years, and as such anyone who doesn’t want to get pregnant should know that it can work really well when used with another method or even by itself when other methods aren’t available. Of course, I would still tell anyone who doesn’t want to get pregnant about the other contraception methods that work even better, and about the importance of condoms to prevent STIs.

While this study paints a more responsible picture of withdrawal users, I
still have a hard time with the promotion of withdrawal as anything
other than “better than nothing” or “something to use when you have no
other options.”

While I understand the point that withdrawal must be listed as a method, I concur wholeheartedly with this statement.

Shan

SUCH a bad idea when there are so many other options available. A few years ago, a friend of mine told me that was the method he and his wife used. They’re in their 40s and have perfectly good health insurance and don’t want any more children. WTH?

http://theflounce.com Jen Pink

Late 30’s here, with my husband more than fifteen years, good health insurance, educated, and have used the pull-out and rhythm methods for almost ten years. I’m not at risk for STD’s, I tried Mirena once and hated it, and I hated taking the pill. I’ve had two kids (planned), one instance where I used Plan B and one abortion. So what?

I understand not advocating its use with a higher risk demographic, but it’s a perfectly safe and sane choice for many people, including couples like your friends. And me and my husband.

Shan

Obviously, your birth control method is your own personal business but you put it out there so I’m just wondering: If you’re done having kids, why doesn’t your husband get a vasectomy? Those are a lot easier than having an abortion.

I just don’t see how the benefits of the method outweigh the risks involved, even in an exclusive long term relationship. How many scares/abortions can one take using FAM and withdrawal before needing to switch to a more reliable method? I just couldn’t completely enjoy sex with that hanging over my head every time.

http://theflounce.com Jen Pink

Maybe it was just a bad time to get pregnant, maybe we weren’t sure we were done… maybe that’s why he hadn’t had a vasectomy. Not that it should matter, but now that we are sure, he is getting a vasectomy. And you’re right, it is my personal business, but I’m willing to share it to illustrate a point. You said it was “SUCH a bad idea when there are so many other options available,” which for me could easily have been a quote from somebody preaching against abortion.

What are the risks that I’m facing exactly? The risk of getting pregnant? For the sake of keeping it simple, I won’t go into all the other potential methods… for this conversation’s purpose, let’s just use condoms. Studies have shown withdrawal (a 4% failure rate) is almost as effective as condoms (a 2% failure rate), so, for me, the benefits far outweigh the risk- because I hate condoms.

I understand that YOU may not be able to enjoy sex with that risk (pregnancy) hanging over your head every time, but I wasn’t bothered. Nothing is 100%, and when I weighed the risk of pregnancy with the benefit of spontaneous sex, sex without condoms, a life without pills, and a life without a troublesome IUD, withdrawal won out. For me. Yes, one time in ten years I got pregnant because WE lapsed with birth control (didn’t practice withdrawal), I realized I didn’t want to be pregnant, and I had an abortion. That could have happened utilizing any method of birth control. And I wouldn’t take it back, because withdrawal worked for me, and when WE slipped and didn’t practice withdrawal, abortion worked for me.

But really, who cares if I (or your friend’s wife) had a million scares and a dozen abortions? I’m not deliberately picking on you, I’ve had this conversation before, so you’re not alone. I just find it fascinating how many people will defend abortion as a choice, but turn around and criticize a couple for choosing withdrawal over something THEY think is more appropriate. “Why not just get a vasectomy?” Cognitive dissonance much? Withdrawal might not be for everyone, when the time comes, I certainly won’t be encouraging my kids to make it their primary birth control tool. But there’s a reason it’s listed on all of those “Methods of Contraception” posters at Planned Parenthood, and it’s not because it’s ineffective.

FlSam

What you see as criticism, many of us see as genuine concern. If it works for you, great. But to promote it as some form of birth control on equal footing as methods like bc pills, iuds, etc. is highly misleading. Its failure rate is much higher because there are far too many variables (like trusting that the man will pull out before climax or that his pre-ejaculate does not contain semen, which there’s no way of knowing). That’s not criticism, it’s simply reality.

http://theflounce.com Jen Pink

Well to start with, I’m not promoting it at all. I just spoke up in defense of Shan’s “friends,” the couple who chose to use it as their primary method. There’s no such thing as “equal footing” as it relates to birth control methods, because people don’t just factor in statistics on efficacy, they also factor in quality of life and individual circumstance. Not everyone can take the pill, not everyone can use an IUD, some people are allergic to latex, not everyone has a trusting and competent partner, not everyone feels the same about how to manage an unwanted pregnancy.

I’m not sure who you’re concerned about, but let’s assume it’s women who aren’t prepared to deal with an unintended pregnancy and who can’t depend on their partner to properly use the withdrawal method… I absolutely concede that there are safer contraceptive choices available to them. But Shan’s remark about her friends (and her later remark about vasectomy being easier than abortion) wasn’t about a global concern so much as it was about a personal criticism. So I was compelled to weigh in with a more empathetic view because in my experience, yes, withdrawal is relatively effective when you have a partner who knows how to practice it properly. And if an educated woman chooses to adopt it (or abortion) as a part of her birth control regimen, then hooray choice.

Shan

“in defense of Shan’s “friends,” the couple who chose to use it as their primary method.”

To clarify, my friend (and I only had his side of the situation since I didn’t know his wife) said he’d been meaning to go get decommissioned for a long time, just never gotten around to it like so many men who won’t even go to the doctor for a checkup nevermind one where they know they’re going to get their penis meddled with. At the same time, he was also complaining about not having as much sex as he would have liked. “Well, duh, man!” So, yeah, I was a bit judge-y with him in an eye-rolling kind of way.

I’m glad it’s worked out for you but I just can’t wrap my brain around it for my own self because I just find the idea vaguely horrifying after hearing about so many failures. Sure, someone who knows what he’s doing could be great but I wouldn’t want to be the test subject for his learning curve.

Arachne646

Me, too!

Alicia Silva Villanueva

I think most methods are very harmful to human health and withdraw is the least harmful how ever it takes practice and discipline, Taoist sex teaches lost of practices that make it into a safety practice, this can help people to have so much better sex and better and multi organismic relationships, for men and women. So why harm your health with hormones? if you can enjoy and not have unwanted pregnancies. I have only used Taoist sex for 20 yrs, It is more sophisticated thing than just withdraw. It does make a difference in your health for men and women.

FlSam

Do you think most men will be ok with having to use the withdrawal “method” permanently? If you think so, either you are naïve or you are a sadist. Either way, it’s not good.

Brea Plum

Your first statement is flatly wrong, as has been proven by decades of use and thousands, perhaps millions, of pages of published research. “Taoist” sex sounds about as reliable and credible as homeopathic medicine. In other words – it’s nothing with a fancy label.

fiona64

I think you’re thinking of dharma, which is not Taoism. /nitpick

And going with nothing is asking to get pregnant.

FlSam

I suspect that most of the people here pushing this method are trolls. Most people who have either used this “method,” or know someone who did, are FULLY aware how completely unreliable it is.

BelligerentBruncher

So that what you told your husband?

#jk

BelligerentBruncher

Being gay is a pretty solid way to not get pregnant.

So is abstinence. Unless we’re talking about virgin birth and stuff. Then you should just start your own religion.